Permit CITY OF TIGARD ELECTRICAL PERMIT
a
` iIt Permit#: ELC2023-00561
'' COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/19/2023
Parcel: 1 S 134DA02000
Jurisdiction: Tigard
Site address: 10900 SW NORTH DAKOTA ST
Project: PETERSON Subdivision: None Lot: None
Project Description: Meter relocation.
Contractor: OWNER Owner: PETERSON, SHAWN G& ERIKA
10900 SW NORTH DAKOTA ST •
TIGARD, OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 09/19/2023 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 09/19/2023 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the
180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throuah OAR 952-001-0090. You�/ m tam�oev-of the rules or direct Questions to OUNC by callina 503.2 19 or .800.332.2344. +
Issued By: ��y,�_r, ,`/� Permittee Signature: T
OWNER INSTALLATION ONLY 1
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC'N Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m,for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
Date/By: g/`��3 ermit#: 4L �®],�V7/t x•;`al sZi
e 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review
0 Phone: 503.718.2439 Fax: 503.598.1 Date/13y: Related Permit#:
Inspection Line: 503.639.4175 EC E I VE D Ready Date/By: rods: /__�_>>/�� ® See Page 2 for
fIG ARU Internet: www.tigard-or.gov Notified/Method: _ Y Supplemental Inform ation
TYPE OF WORKSCT-nr PLAN REVIEW
D New construction Addition/alteration/eji1aecnscnl Please check all that apply(submit 2 sets of plans w.!itoms checked).
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION V v'‘..".7" exceeds 10,000 amps at 150 volts or ❑Floating buildings.
1-and 2-family dwelling Commercial/industrialless to ground,or exceeds 14,000 0 Commercial-use agricultural
y ❑ 0Accessory building amps for all other installations. buildings.
❑Multi-family ❑ Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
.JOB SITE INFORMATION AND LOCATION 0 Emergency system, larger separately derived
0 Addition of new motor load of system.
Job#: Job site address: "-j ,;,.) i.-!,l i ij 1, -"b. ,-,) (.. 1 looHP or more. ❑"A" "E" °I 2" "I-3„
City/State/ZIP: ' C iA-7}'�, ❑Health-care
It more residential units. Recreatiy.
onal
/LC-�3 ` ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: \ �n S O n 1 0 Hazardous locations. ❑Supply voltage for more than
P '_ -N's �l�V!! 0 Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site: '' '. ','
FEE SCHEDULE
Description I (it N. I Lath I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
, (with above sq.ft.) 75.00 2
�//Wc.e.../ii ✓ Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
❑ PROPERTY OWNERI - ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: ( 4/l J r ..A.— EL( Cr- T L. 7 _co r- 200 amps or less / 100.70 j J 70 2
Address: 1 p:t&) Sc..) NO rL 1 1 1 DA<<T� -r. 4- 01 amps to 400 amps 133.56 2
n 401 amps to 600 amps 200.34 2
City/State/ZIP:'1((,k}� 0(Z. 7 Z 7- 3 601 amps to 1,000 amps 301.04 2
Phone: (g)3) Lib-3 "47 3E3 FnA:-(---)--__. Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: 5f{q t„7,1 .5'0-l�J or-) ( Y1/4/(-2 . C 6 NA relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease, lit,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: - ---. ..... Date: Tl_(/2,3 401 amps to 599 amps 168.54 2
❑ PPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lie.: Suprv.Lie.: specifically listed('%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: /,,,,,,,,7 d_
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): f 1_ U Y
Authorized signature: TOTAL PERMIT FEE:Fit?. `-iii
This permit application expires if a permit is not o tallied within 180
Print name: S���W 9 t� �� /c 7„ i Date: ei/ f c (2� days after it has been accepted as complete.
1 J -� l" * Number of inspections allowed per permit.
I:/Building\Permits\ELC_PermitApp ELR ERBdoe Rev 06/17/2015 44046I5Tp I/OS/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Dew HO iion I Qty. I Each Total I
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n Other: Each additional inspection is 66.251 hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90,00i hr
specifically listed(l/i hr min)
COMMERCIAL WORK ONLY: ELECTRICAL(EnterPoI FEES
Fee for each commercials stem: $75.00 Subtotalallowedp t. Page I):
3' • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
• ❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls •
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
P\Building\PermitslELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
;_-i; rN-�.t.)' _1 P r--n--�_,PS D J
Print Name of Permit Applicant
ignature of Permit Applicant Date
Permit#: 64.- 2629-- )56i
Address: / I N it
Issued by: .7 Date: '-7/O Of i-1.
This Copy for Permit Offices